Healthcare Provider Details

I. General information

NPI: 1174294821
Provider Name (Legal Business Name): MICHAEL A. MUISE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 MAIN ST UNIT 2
STONEHAM MA
02180-1613
US

IV. Provider business mailing address

161 MAIN ST STE 3
NORTH READING MA
01864-3172
US

V. Phone/Fax

Practice location:
  • Phone: 978-664-4008
  • Fax: 866-949-9835
Mailing address:
  • Phone: 978-664-4008
  • Fax: 866-949-9835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number25688
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: